PLACING IMPLANTS FOR PATIENTS WHO HAVE HAD RADIATION THERAPY

Human teeth and dental implant in jaw orthodontist medical vector illustration. Health technology and implantation prosthesis

A gentleman came to our office recently for evaluation for dental implants. He had undergone radiation and chemotherapy for head and neck cancer a number of years ago. He had been to another surgeon recently and had a consult regarding dental implants and was told that he would need HBO (hyperbaric oxygen) treatment prior to his dental implant care. Since this had been presented to him as a treatment option, it almost becomes a mandatory treatment from a medical legal standpoint, but in my heart I feel it is unnecessary.

It has been my experience that most patients who have undergone treatment for head and neck cancer, including high dose radiation and chemotherapy, can have dental implants with an expected high success rate (J Oral Maxillofac Surg 74:1965-1973, 2016).

There are other factors which need to be evaluated and tended to if needed. The presence of bone problems would be a concern including overall health, presence of autoimmune disease, and nutritional status. You must go into it with your eyes open that problems, even late problems, can arise. One speaker I heard had given an enlightening example: if you expect that your patient would heal after a jaw fracture then they should heal with a dental implant. The spirit of this is that the ability of the jaw to heal at any site will be about the same whether it is a dental implant or other disorder.

My protocol is to be even more conservative with sequencing of care. I would place the implant and allow bone healing for at least 6 months prior to loading the implant. The character and appearance of the bone at the time of placement is also a guide. If I find that the bone is particularly fibrous or has a poor blood supply, I would not place the implant. Unfortunately HBO therapy may help in the short run, but it may not be a long term solution with something like a dental implant.

The bottom line is that we usually can place dental implants for a patient who has undergone radiation therapy as part of treatment for head and neck cancer.

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